Appellant also had some difficulty orienting to her circumstances at the
hearing. Responding to the first examiner, Mohler, she said that she did not know why
she was in the courtroom. To his direct question whether she knew why she was before
the judge, she answered with the phrase, "[d]own on Market Street somewhere." In quick
succession, she said she did not know why she was in the hospital but then said she was
there "because I'm crazy." She said she had been hospitalized for 48 days, when the
hearing occurred four days after she entered the medical center. But appellant then
accurately told the examiner that she was at home the week before the hearing and she
told the judge that she had been hospitalized for five days. She knew she had taken
medication in the past--in her words, was "forced to take medication"--but said that it was
for sleeping and she had taken such medicine "[s]ince I was three years old." When asked
if she had a history of "manic depression," she said she had been depressed, but connected
it to a time when her "leg was broke when I was eight, three years or four."

Despite those signs of confusion, appellant accurately recited many facts
about her circumstances at the time of the hearing. She knew the date, the time of day,
and that she was almost four months pregnant, with a due date in mid-January. She gave
her apartment address, reported an amount of cash that she had on hand to pay for a taxi
to take her home, and told the court that she could borrow more money if needed and pay
it back quickly. She said that she had a car, although she was not sure whether it was at
her house or her aunt's. She said that she lived near a Safeway where she bought her
food. When asked if she had thought about cutting off her legs with a whisky bottle, she
answered "Mm-hm," a phrase that we are able to infer meant "yes" throughout her
testimony. But she also elaborated that she had "never tr[ied] that" and was not thinking
about it currently because she has her house and needs to cook. In response to direct
questions about whether she would harm herself, appellant said that she had "tr[ied] to
kill myself but I couldn't do it," and that such incidents had happened in "1998, and
maybe sometime before," "when I was younger."

When Mohler asked why she was refusing to take her medication, appellant
replied, "Because it's not good. * * * you can be choked or whatever, you know."
Appellant answered affirmatively to his follow-up question, "You think the medicine's
choking you?" When O'Malia asked her whether doctors had told her to "stay on your
medication," appellant replied,

"No. Because I don't have any medication. I stop taking long time,
years. And I tried again and I -- I -- no. They make you go having sex on
streets, you know, even on your car, on the top of the buildings
somewhere."

At another point, appellant testified, "No, I don't need any medication, no. Because you
can see I don't need them. I don't need any medication around here." She also said that
she had recently refused to provide a blood sample because "[e]verywhere, [are] stores,
they can buy wine * * * [a]nd beets, red beets, and they can make a lot of blood if they
need." She admitted that she had screamed at the nurses and she offered the opinion that
nurses "stink." However, we infer from appellant's testimony that she had allowed other
blood draws during her precommitment hospitalization and had only refused the most
recent request.

Although she admitted that she was refusing medication for her psychiatric
care, appellant gave uncontradicted testimony that she had not refused prenatal care. In
answer to one examiner's statement that there was "some concern that you haven't been
following through with the prenatal care," appellant said that she had gone to two prenatal
appointments and had given sonogram pictures of her baby to her mother and brother.
However, the extent of her scheduled prenatal appointments is not in the record.

Throughout the hearing, appellant vacillated about whether she would
willingly return to the hospital. First she said she would stay there, even though in her
view they make her clean like a janitor, but that she would need food and good coffee.
As the judge began to announce his determination of appellant's status, she interrupted to
ask if she could go home to shower and wash her clothes before returning to the hospital.
When the judge denied her request, appellant became agitated; asked her attorney to
release her; said, "I was there for five days. It's enough, okay?"; and then told the court
she wanted to go home, not back to the hospital.

The two court examiners agreed with the precommitment investigator that appellant
suffers from bipolar disorder, manic phase. O'Malia's report concluded that appellant's
"[j]udgment is severely impaired--problem solving is overly simplistic"; her "[i]mpulse
control [is] impaired," as shown by her inability to sit during the hearing; and she shows
"delusional thinking" about having to work like a janitor in the hospital and smelling
odors in the courtroom. Mohler wrote in his report that appellant's condition is
characterized by "delusional thinking," "poor judgment," and "no insight."

The court committed appellant on the "basic needs" ground:

"The Court then will rely on the findings and conclusions of the examiners
which I will adopt and incorporate in making my final decision. * * * [T]he
Court does find at this time that there's clear and convincing evidence that
[appellant] suffers from a mental disorder and is unable to provide for her
basic personal needs, and will not receive any care necessary for her health
or safety. * * * It is therefore ordered that [appellant] be committed[.]"

On appeal, appellant argues that the state did not carry its burden to show
that she is a "mentally ill person." We agree with appellant. The elements to be proved
and the burden of proof are statutory. ORS 426.005(1)(d) provides in part:

"'Mentally ill person' means a person who, because of a mental
disorder, is one or more of the following:

"(A) Dangerous to self or others.

"(B) Unable to provide for basic personal needs and is not receiving
such care as is necessary for health or safety."

ORS 426.130(1) provides in part:

"After hearing all the evidence, and reviewing the findings of the
examining persons, the court shall determine whether the person is mentally
ill. If, in the opinion of the court, the person is:

"(a) Not mentally ill, the person shall be discharged forthwith.

"(b) Mentally ill based upon clear and convincing evidence, the
court:

"* * * * *

"(C) May order commitment of the individual to the Department of
Human Services for treatment[.]"

Thus, a court-ordered commitment requires proof to a clear and convincing standard,
ORS 426.130(1)(b), that appellant is "mentally ill," meaning that (1) she has a mental
disorder; (2) she is dangerous to self or others, or is unable to provide for her basic
personal needs and is not receiving necessary care for health or safety; and (3) the mental
disorder is a cause of her dangerousness or of her inability to provide or receive care to
meet basic personal needs, ORS 426.005(1)(d)(A), (B). Because we review the record
supporting a commitment order de novo, the particular ground on which the court
committed the appellant does not limit our review. See State v. Turel, 182 Or App 235,
241, 48 P3d 175 (2002) (addressing "danger to self" where trial court ordered
commitment on "basic needs" criterion).

We first consider the "basic needs" ground on which the trial court relied.
We have previously explicated the "basic needs" commitment standard:

"The legislature's 'basic needs' commitment standard focuses on the
capacity of the individual to survive, either through his own resources or
with the help of family or friends. The state must establish by clear and
convincing evidence that the individual, due to a mental disorder, is unable
to obtain some commodity (e.g., food and water) or service (e.g., life-saving
medical care) without which he cannot sustain life. The statute does not
express a standard by which the imminence of the threat to life must be
measured.

"A speculative threat, such as the failure to take medicine under the
circumstances in State v. Brungard[, 101 Or App 67, 71, 789 P2d 683,
modified on recons, 102 Or App 509, 794 P2d 1257 (1990), rev den, 311 Or
427 (1991)], is not by itself sufficient. However, the state need not
postpone action until the individual is on the brink of death. The goal of the
commitment statute is safe survival, not merely the avoidance of immediate
death."

State v. Bunting, 112 Or App 143, 145, 826 P2d 1060 (1992) (emphasis added). To meet
the standard of an imminent threat to health and safety, the state must show that "there is
a likelihood that the person probably would not survive in the near future because the
person is unable to provide for basic personal needs." Id. at 146 (emphasis added).
Furthermore, "[a] person's ability to care for herself is assessed in the light of existing, as
opposed to future or potential, conditions." State v. Headings, 140 Or App 421, 426, 914
P2d 1129 (1996) (citing State v. Stanley, 117 Or App 327, 330, 843 P2d 1018 (1992)).

The standard of an imminent threat to "safe survival" is not met here.
Appellant gave undisputed testimony that she had an apartment, a car, money and access
to additional financial resources, and that she cared for herself by shopping and cooking.
The medical providers involved with her care at the time of the hearing knew appellant
had family members living nearby who monitor her and assist with her self-care. No one
testified to an inability of the family to continue to assist appellant. No family, friends, or
service providers testified to an inability of appellant to obtain commodities or services
that are necessary to sustain her life. Inability to provide for "basic needs" requires "facts
and observations that lead to such a conclusion." Stanley, 117 Or App at 330.

The evidence in the record addresses two aspects of appellant's current
behavior and circumstances related to "basic needs" that might threaten her health, but do
not imminently threaten her life: her refusal to accept psychiatric medication, and her
alleged refusal to obtain prenatal care. The record clearly and convincingly shows by her
own admission that appellant refuses medication to treat her mental disorder. However,
the record does not show that appellant has progressive symptomatic deterioration
because she is refusing medication, unlike the situation we considered in State v. Jayne.
174 Or App 74, 82, 23 P3d 990, rev den, 332 Or 316 (2001) (appellant was progressively
deteriorating over course of a year). The available evidence covers only the short time
period from August 2 to August 6. In that time, appellant's condition demonstrates
consistent, not worsening, manic symptoms such as tense speech, intense affect, lack of
insight that she was thinking and behaving strangely, a single instance in her testimony of
unusual sexual thinking, and tangential comments in response to internal stimuli.
Appellant's delusional thinking as it is shown in the record--namely, a comment that
nurses could substitute wine or beet juice for her blood and confused responses to some
questions--does not support an inference that she could not care for herself in a way that
was life-threatening with any degree of imminence.

As for appellant's alleged refusal of prenatal care, the record simply does
not support that inference. Appellant denied that she had refused prenatal care. She
consistently said, from the precommitment investigation forward, that she knew she was
pregnant and wanted to have her baby. No evidence connects appellant's single blood
draw refusal in less than a week of psychiatric hospitalization to prenatal care. We cannot
say that two monthly appointments and a sonogram by the fourth month of pregnancy
would be materially less than the recommended amount of prenatal medical services.

In fact, mere refusal to cooperate in her own psychiatric care and
hospitalization are the predominant themes of the precommitment investigation and the
court examiners' reports. Among many examples, appellant was "not cooperative with
the interview," was "irritable," and "all comments were focused around getting out of the
hospital immediately." (Emphasis added.) According to the precommitment report,

"[s]he made repeated demands to be released. Insight and judgment were
impaired and she clearly does not want to take medications. * * * She
escalated when I told her I would not release her and * * * when I told her
we would go to court and talk with the judge."

Mere rejection of psychiatric hospitalization, treatment for the mental disorder, and
related judicial proceedings cannot be sufficient to establish failure to meet "basic needs."
That line of reasoning would be hopelessly circular, imposing involuntary commitment on
anyone who refuses to accept commitment and treatment. Understandably, the state and
trial court are concerned about "future or potential conditions" of self-care if appellant
experiences further mental deterioration. But, as we have often stated, potential
conditions do not meet a standard that represents "a likelihood that [appellant] probably
would not survive in the near future." Bunting, 112 Or App at 146; see alsoHeadings,
140 Or App at 426 (same); Stanley, 117 Or App at 330-31 (same).

We turn to whether appellant meets the requisite conditions for commitment
based on "danger to self."

"[T]he state must show that appellant's mental disorder has resulted in harm
to herself * * * or created situations likely to result in harm. Although the
danger to self standard does not require a threat of immediate harm,
consistent with the basic needs standard, the threat must exist in the near
future."

State v. Hambleton, 202 Or App 526, 534, 123 P3d 370 (2005) (emphasis added) (internal
quotation marks and citations omitted). One unavoidable aspect of finding a "threat must
exist in the near future" is that the person must show current indicators, symptoms, or
behaviors that threaten harm or follow a similar pattern that led toward harm in the past.
Essentially, this observation is closely related to the third element of the statute, that of
causation: "Danger to self" must be caused by the person's present mental disorder to
justify intervention to protect her from her own dangerous state. Without proof of the
element of causation, we risk judging and committing individuals based solely on their
history of mental health problems rather than to satisfy a current need for protection. It is
worth restating here the rationale for the rigorous burden of proof in civil commitment
matters. That standard is

"not merely abstract or precatory. Rather, [it is] the product of a
fundamental recognition of the priority of preserving personal liberties in
civil commitment cases. The tension between the protection of personal
liberties and the provision of medical help to persons with mental disorders
can be relieved only if courts strictly adhere to the statutory requirements
for involuntary commitment and ensure that there is an evidentiary basis
that satisfies each of those requirements."

Id. (internal quotation marks and citations omitted).

Here, we first note that the cumulative evidence of appellant's refusal to
accept treatment, lack of insight, and disordered thinking fails to support the "danger to
self" criterion in the same way that it does not support "basic needs."

Second, we consider the evidence in the record of past and potential self-harm, which are appellant's admissions that she made undefined suicide attempts in 1998
or earlier and that she threatened to harm herself during her current symptomatic episode.
A person who has established a pattern of actions that lead to destructive behavior and
begins to follow that pattern again can be found dangerous. See State v. Lawrence, __ Or
App __, __, __ P3d __ (September 27, 2006) (slip op at 5) (danger to another); State v.
Roberts, 183 Or App 520, 524, 52 P3d 1123 (2002) (danger to self). Here, the state failed
to introduce sufficient facts of a past pattern or show that a pattern is beginning again.

Furthermore, "[p]ast verbal acts * * * must be supported by evidence that
they clearly form a foundation for predicting future dangerousness." State v. Jepson, 48
Or App 411, 416, 617 P2d 284 (1980). Here, no evidence links anything about
appellant's temperament or situation at the time of the possible prior acts of self-harm to
her current condition. Beyond appellant's admission that she recently said she wanted to
harm herself, there is no evidence by which to evaluate the seriousness and imminence of
that threat. To the contrary, appellant testified that she did not currently have that thought
or plan. The state introduced no evidence to contradict or discredit appellant's testimony.
As with our recent conclusion in Hambleton, "concerns about potential harm to appellant,
while understandable, are conjectural and speculative. Apprehensions, speculations and
conjecture are not sufficient to prove a need for mental commitment." 202 Or App at
534-35 (internal quotation marks and citation omitted). Without speculating what
evidence would be sufficient, we conclude here that the state failed to show to a clear and
convincing standard that appellant's recent verbal threat, standing alone, represented an
imminent danger to self.

Reversed.

1. We omit hearsay parts of the record, such as the statement in the precommitment
investigator's report that appellant referred to a husband, "even though she does not have a
husband and lives alone." Neither appellant nor any other witness testified about whether she
had a husband. See State v. Hambleton, 202 Or App 526, 528 n 2, 123 P3d 370 (2005) (excluded
as hearsay whether the appellant was found sitting in a truck naked because no one testified to
that observation at the hearing).

2. Appellant is a naturalized citizen who seems to speak English fluently but may
speak with an accent. We note that some combination of these circumstances affected what was
captured in the hearing transcript, because our de novo review is limited to the record before us.
Some of the court examiners' remarks were not captured either, as we note below.

5. The investigator's and examiners' conclusory statements about prior self-harm
based on hearsay are not available for us to consider on this record. The state correctly points out
that examiners may rely on hearsay of a type reasonably relied on by experts in the field to form
opinions on the subject, see ORS 40.415. Nonetheless, the factual record must support the
examiners' opinions. "[I]n reviewing the record, we require examiners to fully explain the facts
and observations that led them to a particular conclusion." State v. Johnson, 131 Or App 561,
564, 886 P2d 42 (1994).